Health Care Current – September 1, 2015

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This is how the first conversation with one of the two specialists I recently started seeing began. Nothing about the way that Dr. Williams introduced himself struck me as out of the norm. But, it did stand in stark contrast to my conversation with Dr. Bhattarai, who walked into the exam room and introduced himself as “John.” While over the years I’ve gotten to know many physicians both professionally and personally whom I call by their first name, this was the first time that a doctor I was seeing asked me to call him by his first name.

John’s last name is, admittedly, both difficult to spell and to pronounce. So at first I thought he was saving both of us from the “it’s pronounced like this” conversation. After thinking about it for several days, I asked him about it. John explained that he feels it builds rapport with patients and that perhaps patients would be more at ease telling him about their concerns and asking questions. Similarly, he feels he is much more likely to get the information he needs – observations about the patient’s condition – that will improve outcomes if he goes by his first name with the other members of his care team.

Results from Deloitte’s 2014 Survey of US Physicians demonstrate that John is not the only physician concerned with rapport and communication. When asked about the most important capabilities future physicians will need, 91 percent of the respondents rated interpersonal and communication skills as important or very important, beating out health IT capabilities and managerial expertise. This held true across the board, whether the respondent was a primary care physician (PCP) or a specialist.

This may seem like a “no brainer” to many, but to me it was striking. Maybe going on a first-name basis is one step toward better interpersonal communication?

When I picture the ideal physician-patient relationship, I see patients (or consumers) and physicians as partners in treatment decisions. Each side brings its own vantage point to the table: Consumers bring their values and priorities, information about their symptoms, and willingness to take steps to manage their own condition. Physicians bring their knowledge, experience, and willingness to listen.

Results from Deloitte’s 2015 Survey of US Health Care Consumers suggest that more than ever, consumers today prefer to partner with their doctor rather than having their doctors make treatment decisions for them. Nearly half (48 percent) of consumers prefer to partner with their doctor, which is up from 40 percent in 2008. Fewer people want to make decisions by themselves and fewer want their doctor to make decisions for them. To me, this suggests a healthy dynamic and increasing patient engagement.

However, the survey also revealed that only one in three consumers strongly believes physicians should encourage patients to research and ask questions about their treatment. I wondered whether a different, less formal relationship with physicians (maybe even calling them by their first names) might encourage consumers to become more aware of options, side effects, and steps they can take to manage their condition.

Despite general support for the idea of patients questioning doctors about treatment options, the share of people who report actually doing this is low. Only 16 percent of consumers who received care for an injury, illness, or health condition reported asking their doctor to consider treatment options other than the one he or she initially recommended.

The picture changes a bit when we shift the focus to cost of care. Although about two-thirds of physician respondents told us they consider comparative clinical and cost-effectiveness information when making treatment decisions for their patients with high cost-sharing, fewer (53 percent) said that they were comfortable discussing the cost of treatments with patients. Contrast this with the consumer respondents, where 58 percent said that doctors should provide this information. This may be another scenario where better communication – whether it is supported by a first name basis or not – might encourage more engaged consumers, which so many are hoping to see in the future.

I asked a group of friends what they thought about being on a first-name basis with their physicians. Most in my age and professional group preferred to use more traditional last names. One friend even said, “If I am standing there without any clothes on, I want to be Mrs. Smith and for the doctor to be Dr. Jones.”

For now, maybe the best bet for a strong partnership between patients and physicians – at least on the name front – is just asking each what they prefer.

P.S. In observance of the Labor Day Holiday, we will not publish a Health Care Current on Tuesday, September 8, 2015.

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